/ EUROPEAN COMMISSION / TRANS-EUROPEAN TRANSPORT NETWORK / A1
Proposal TENtec Nr.
Annual Call 2012 (please see the amended Annual Work Programme 2012)
Priority 1: Acceleration/facilitation of the implementation of TEN-T projectsRail transport
Inland Waterways
Maritime transport
Road
Integrated and multi-modal transport system
Priority 2: Promote innovation and new technologies for transport infrastructure and facilities contributing to decarbonisation or the reduction of external costs in general
Priority 3: Support to Public Private Partnerships (PPPs) and innovative financial instruments
Priority 4: Support to the long term implementation of the TEN-T network, in particular development of corridors that shall enable a coordinated implementation of the network
Multi-Annual Calls 2012 (please see the amended Multi-Annual Work Programme 2012)
Priority Projects concerning rail, road and inland waterways (PPs)European Rail Traffic Management Systems (ERTMS)
River Information Services (RIS)
Air Traffic Management (ATM)
Motorways of the Sea (MoS)
Intelligent Transport Systems (ITS), including the European Electronic Toll Service (EETS)
For Priority Projects only:
New actions on Priority Projects concerning rail, road and inland waterways (PPs)Ongoing actions Priority Projects concerning rail, road and inland waterways (PPs) with new activities
Ongoing actions Priority Projects concerning rail, road and inland waterways (PPs) without new activities
For ERTMS proposals only:
Priority Area 1: TestingPriority Area 2: Upgrade or equipment of lines with 2.3.0d or baseline 3
Priority Area 3: Upgrade or equipment of trains with 2.3.0d or baseline 3
Priority Area 4: Projects addressing technical issues contributing to the implementation of the ERTMS or contributing to the implementation of the Memorandum of Understanding of 16 April 2012
For Intelligent Transport Systems (ITS), or European Electronic Toll Service (EETS) proposals only:
Priority Area 1: ITSPriority Area 2: EETS
Proposal type
Please select the proposal type:
StudyWork
General Information on the Proposal
Title of the proposed action
Priority/Horizontal project / 00 ▼ / Section (only for PP) / 0000
Transport mode
Start date of the Action / End date of the Action
Summary (up to 2000 characters)
Application Form Part A
/ EUROPEAN COMMISSION / TRANS-EUROPEAN TRANSPORT NETWORK / A2.1
Proposal TENtec Nr. / Applicant Nr
Applicant
Applicant's legal name
Administrative data
Legal address
Street name / Number
Town / City
Postal Code / Cedex
Country
Legal status of the applicant
Please select the legal status of the applicant (see definitions in Annex 2 of the Guide for Applicants).
Member StatePublic sector body
European Economic Interest Grouping (EEIG)
Private undertaking or body
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Application Form Part A/ EUROPEAN COMMISSION / TRANS-EUROPEAN TRANSPORT NETWORK / A2.2
Proposal TENtec Nr. / Applicant Nr
Contact points
Person in charge (the person who will be contacted by the EU in the first instance)
Family Name / First name(s)
Function
Is the address different from the legal address (of section A2.1)? / YES / NO
Street name / Number
Town / City
Postal code / Cedex
Country
Phone
Fax
Representative authorized to sign this application
Family Name / First name(s)
Function
Is the address different from the legal address (of section A2.1)? / YES / NO
Street name / Number
Town / City
Postal code / Cedex
Country
Phone
Fax
Date
Stamp + Signature
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Application Form Part A/ EUROPEAN COMMISSION / TRANS-EUROPEAN TRANSPORT NETWORK / A2.3
Proposal TENtec Nr. / Applicant Nr
FINANCIAL IDENTIFICATION FORM
All applicants must provide the official Financial Identification Form. The form is available for downloaded in all EU languages at: http://ec.europa.eu/budget/contracts_grants/info_contracts/financial_id/financial_id_en.cfm
Please attach this form filled and stamped to the proposal, along with additional documents referred to in the Financial Identification Form.
Information to be provided by applicants classified 'EEIG' or 'private undertaking or body' in section A 2.1 only:
The indicated bank account is interest bearing / Yes / NoREMARKS:
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Application Form Part A/ EUROPEAN COMMISSION / TRANS-EUROPEAN TRANSPORT NETWORK / A2.4
Proposal TENtec Nr. / Applicant Nr
If the applicant is a Member State, fill in the below section on the
Public or private undertaking or body(ies) which will implement the Action
Implementing body's legal name
Administrative data
Legal address
Street name / Number
Town / City
Postal code / Cedex
Country
If there are more than one implementing body, indicate them all.
If the applicant is a Public or Private undertaking or body, fill in the below section on the ministry approving this proposalMinistry's legal name
Administrative data
Legal address
Street name / Number
Town / City
Postal code / Cedex
Country
Representative authorized to sign this proposal
Family name / First name(s)
Function
Is the address different from the legal address? / YES / NO
Street name / Number
Town / City
Postal code / Cedex
Country
Phone
Fax
Date
Stamp (*) + Signature
(*) Stamp of the competent Ministry
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Application Form Part A/ EUROPEAN COMMISSION / TRANS-EUROPEAN TRANSPORT NETWORK / A2.5
Proposal TENtec Nr. / Applicant Nr
Coordinating Applicant
(only for applications with more than one applicant)
Please, select the Legal Entity that will act as Coordinating Applicant
Legal Entity (Applicant or Implementing Body) / Coordinating ApplicantContact points
Person in charge (the person who will be contacted by the EU in the first instance)
Family Name / First name(s)
Function
Is the address different from the legal address (of section A2.1)? / YES / NO
Street name / Number
Town / City
Postal code / Cedex
Country
Phone
Fax
2
Application Form Part A/ EUROPEAN COMMISSION / TRANS-EUROPEAN TRANSPORT NETWORK / A3.1
Proposal TENtec Nr.
Location of the Action
Member State(s) / ▼ / ▼ / ▼ / ▼ / ▼
Region(s) (1) / ▼ / ▼ / ▼ / ▼ / ▼
(1) NUTS 2 nomenclature will be used for the regions.
Geographical co-ordinatesDMS Format (2) / DD Format (3)
Longitude / Latitude / Longitude / Latitude
Start point / :: ▼ / :: ▼
Interim point 1 / :: ▼ / :: ▼
… / :: ▼ / :: ▼
Interim point n / :: ▼ / :: ▼
End point / :: ▼ / :: ▼
Is the proposal addressing a cross border section (4)? / Yes / No
Please note that these coordinates are a minimum requirement. In addition, you are strongly encouraged to submit cartographic information on the geographical location of the planned activities. Please see Annex 3, Point 2.7 of the Guide for Applicants for technical specifications.
(2) DMS stands for Degrees, Minutes and Seconds.
(3) DD stands for Decimal Degrees. In this case, longitude and latitude must be given in a seven digit number (+ or - sign followed by three digits and four decimals).
(4) Please see the definition of cross border sections endorsed by the Committee for Monitoring Guidelines and the Exchange of Information available at: http://tentea.ec.europa.eu/download/calls_2012/definition_cross_border_sections_en.pdf.
Activities of the ActionActivity number / ISIC code (3) / Activity name / Start date / End date / Verifying milestone
▼
▼
▼
▼
(3) For complete description and other codes, see: http://unstats.un.org/unsd/cr/registry/regcst.asp?Cl=17
Milestones of the ActionMilestone number / Milestone name
(including milestones at start and end date of the Action) / Expected date / Means of verification
Contribution of the Action to the TEN-T policy objectives
If the Action is part of a Global Project previously supported under the TEN-T budget, please specify:
Decision number / Title2
Application Form Part A/ EUROPEAN COMMISSION / TRANS-EUROPEAN TRANSPORT NETWORK / A3.2
Proposal TENtec Nr.
Financial information
Global project
SOURCES OF FINANCING / * Financial Contribution (in euros) /
1. State budget (-s)
2. Regional/local budget(s)
3. Project promoter
4. EIB loan
5. Other loans
6. TEN-T financing
7. Other EU funds (ERDF, CF, FPR)
8. Public Private Partnerships
9. Other sources
Total
For multi-beneficiary projects, please give only the total amounts per category.
Proposed ActionSOURCES OF FINANCING / (*) Total financial contribution / 2012 / 2013 / 2014 / 2015
1. State budget(s)
2. Regional/local budget(s)
3. Action promoter
4. EIB loan
5. Other loans
6. TEN-T financing
7. Other sources
Total
(*) contribution to eligible costs only
For multi-beneficiary actions, please split state, regional budgets and applicant's self-financing by applicant.
All amounts must be in euros.
If applicable, please indicate the exchange rate used for preparing the applications:2
Application Form Part A/ EUROPEAN COMMISSION / TRANS-EUROPEAN TRANSPORT NETWORK / A3.3
Proposal TENtec Nr.
Indicative breakdown of estimated eligible costs of the Proposed Action by activity
Activities / 2012 / 2013 / 2014 / 2015 / Total eligible costs
1.DIRECT COSTS
1.1 Activity 1
1.2 Activity 2
1.3 Activity 3
1.4 Activity 4
1.5 Activity 5
1.6 Activity 6
….
1.N Activity N
TOTAL DIRECT COSTS
2. INDIRECT COSTS (*)
TOTAL ELIGIBLE COSTS
Please give an indicative breakdown of the estimated eligible costs of the proposed Action (i.e. the action for which a financial contribution from the TEN-T Programme is requested in this proposal) by activity (as defined in section A3.1) and year (all amounts must be in euros).
(*) Costs which are not identifiable as direct costs, but which have nevertheless been incurred in connection with the eligible direct costs of the action. Indirect costs shall satisfy the general criteria specified at article III.3.7.1 of the General Conditions and may be eligible for flat rate funding fixed at no more than 7% of total direct eligible costs.
Applicants will be asked to explain the methodology used in determining the percentage of flat rate (between 0 and 7%) before concluding the individual decision.
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Application Form Part A/ EUROPEAN COMMISSION / TRANS-EUROPEAN TRANSPORT NETWORK / A4
Proposal TENtec Nr.
Please specify, for each Part of the Application Form, the language in which it is being submitted. If the language is not English, indicate whether you will provide an English translation before the deadline specified in the Guide for Applicants.
Project summary-Application Form Part A- In what language have you completed the project summary in Application Form Part A? (drop-down menu with 23 official languages)
- If the project summary in Application Form Part A is not in English, will you submit an English translation before the deadline specified in the Guide for Applicants (see Section 6.3.2 of the Guide for Applicants)?
YesNo
Application Form Part B1
- In what language have you completed Application Form Part B1? (drop-down menu with 23 official languages)
- If Form Part B1is not in English, will you submit an English translation before the deadline specified in the Guide for Applicants (see Section 6.3.2 of the Guide for Applicants)?
YesNo
Application Form Part B2
- In what language have you completed Application Form Part B2? (drop-down menu with 23 official languages)
- If Form Part B2is not in English, will you submit an English translation before the deadline specified in the Guide for Applicants (see Section 6.3.2 of the Guide for Applicants)?
YesNo
Annexes do not need to be translated unless the applicant deems this necessary.
Translation costIf you will submit any English translations, please give an estimate of the total cost of the translation. / €
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